Minnesota Title V MCH Needs Assessment Fact Sheets

Pregnant Women, Mothers and Infants

Access to Primary Preventive Health Care

Summer 2004

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Size of the Problem

Over 68,000 babies are born annually in Minnesota and over 1,096,832 women of childbearing age (15 to 44 years old) reside in the state [1]. All Minnesota infants and women in the child-bearing ages are in need of primary preventive health care. Greater accessibility of primary care is associated with better health outcomes [2].

Based on Minnesota health insurance data and access to preventive services, an estimated 1,768 infants/children <24 months of age are without health insurance and an estimated 55,760 infants/ children <24 months of age have not met the C&TC infant/child well child health guidelines.

Seriousness

People affected by lack of access to primary, preventive health care
Pregnant women and their newborn babies require continuous health insurance coverage during prenatal, neonatal and infancy periods. Additionally, even if health insurance coverage is available, there may be barriers to accessing the health care services. The Healthy People 2010 goal is to improve access to comprehensive, high-quality health care services. One of the objectives is to increase the percentage of children who have access to a source of ongoing care from 93% in 1998 to 97% by 2010 [3,4,5].

Health insurance coverage for mothers and newborns in the state is good for infants, but spotty for women as indicated by the following data:

  • Children were more likely to have a medical home if a parent reported having a medical home [6]. Studies indicate that children whose mother had less than adequate prenatal care utilization had significantly fewer well-child visits and were significantly less likely to have adequate immunizations [7].
Health Insurance Coverage of Minnesota Children, 2001
  Percentage
MN 2004 Goal
100%
Minnesota (2001)
94.50%
U.S. Average
88%
Sources: 2001 MN Health Access Survey. MDH Health Economics Program. ChildTrends DataBank. Health Care Coverage for 2001.
  • Although children under 2 were more likely to have a medical home than older children, these children have difficulty accessing primary preventive care services according to a recent Minnesota parent survey [6]. Of these infants and children under 24 months of age, only 49.8% received a well child visit as recommended by the American Academy of Pediatrics (AAP) and 59.2% received a visit according to the Child and Teen Checkups Program (C&TC) infant/child visit guidelines [6].
  • Having health insurance coverage is a strong determinant for having a “usual source of medical care” or “medical home”. State surveys have found that 43.7% of uninsured (> 1 year) survey participants did not have a usual source of care [8]. For Minnesotans uninsured for less than 1 year, 24.1% did not have a usual source of care.
  • Slightly more than forty-nine percent (49.3%) of Minnesota businesses offer health insurance to their employees- a slight decline since 1997. Rural Minnesota businesses are less likely to offer health insurance (38.6%) than their twin cities (55.9%) counterparts [9].
  • Of Minnesota women without a usual source of medical care, 27.1% are uninsured and 3.9% have private insurance coverage [9].
Health Insurance Coverage of Minnesota Children by Race/Ethnicity, 2001
  U.S. 2001 MN 2001
African American
86%
89%
Hispanic
76%
84.2%
White
93%
96.6%
Sources: MDH. Populations of Color. Health Status Report. Fall 2003. Child Trends DataBank-2001 www.childtrendsdatabank.org [Attn: Non-MDH Link]

Disparities

  • Non-white children were more likely that white children to meet the well child visit guidelines [6].
  • Non-white or Hispanic children were less likely to have health insurance (95.5% of white children <18 years of age compared to 90.9% of non-white or Hispanic children) [6].
  • Nationally, 28% of all children under the age of 5 years are covered by Medicaid for their health insurance. African American (38%) and Hispanic (35%) children are more likely to be covered by Medicaid [3].
  • Children living in Greater Minnesota were less likely to receive preventive well child checkups than children living in the Twin Cities [6].

Economic
Preventive health care saves long term costs by providing an opportunity to detect and treat conditions early and promote health on issues such as development, nutrition and safety. No specific cost-savings data were available.

Interventions

Recommendations for interventions that improve accessibility and timeliness of care include:

  • Making appointment-scheduling systems more flexible;
  • Increasing the use of mid-level practitioners such as physician assistants and nurse practitioners;
  • Offering group appointments with team care;
  • Scheduling telephone consultations or using electronic communications (with appropriate reimbursement) to supplement face-to-face care; and
  • Extending after-hours (evening and weekend) care.

Effectiveness of Interventions
National research found that a series of well child visits during the first 2 years of life prevents avoidable hospitalizations among children in Medicaid, despite race, ethnicity, region, and level of poverty [10].

Studies of Early and Periodic Screening, Diagnosis and Treatment (EPSDT) programs in Michigan, North Dakota, Virginia, and Pennsylvania have documented effectiveness in improving children’s health status and lowering their medical costs [11].

Status

Minnesota Resources
Public health has programs and strategies that promote access to primary preventive health care include:

  • Focus groups have been conducted by MDH with diverse residents and community-based organizations that serve them. Focus groups in rural Minnesota have also been conducted. Recommendations from these meetings have been communicated statewide [12,13].
  • The Cover All Kids initiative sponsored by Health Plans, the Children’s Defense Fund and the State of Minnesota offers information about insurance coverage for families in Minnesota.
  • Children’s Defense Fund – Minnesota Low Cost Health Directory. Health care options for uninsured or poorly insured families with children including information on Medical Assistance; MinnesotaCare; and other low cost or free health services available in each county in Minnesota. www.cdf-mn.org/health.htm [Attn: Non-MDH Link]
  • Each Minnesota county and some tribes have a C&TC coordinator. C&TC coordinators provide timely information to eligible families/ children about the health care benefits of the C&TC Program. They assist families/children to access C&TC services, make appointments, arrange for transportation and interpreters. They look for additional creative ways, beyond required activities, to provide effective outreach to the diverse populations within counties, CHB(s) and tribes.
  • Home visiting programs available in some local communities have a program goal to increase access to health care for the families served.

Community Awareness
No documentation on the extent of community awareness in Minnesota about maternal and infant need for access to primary preventive health care was available.

References

1. Minnesota Center for Health Statistics. 2003
2. Shi L, et al. Primary Care, Self-Rated Health and Reductions in Social Disparities in Health. Health Serv Res 2002. 37:529-50.
3. Child Trends Data Bank. 2003 www.childtrendsdatabank.org
4. Kaiser Family Foundation. State Health Facts Online, Minnesota. www.statehealthfacts.kff.org [Attn: Non-MDH Link]
5. Healthy People 2010. Accessed 7-14-04.
www.healthypeople.gov/Document/HTML/Volume1/01Access.htm#_Toc489432807 [Attn: Non-MDH Link]
6. MDH, 2002 BRFSS Child Health Module Data Book, March 2004.
7. Kogan M, Alexander G, Jack B, Allen M. The Association Between Adequacy of Prenatal Care Utilization and Subsequent Pediatric Care Utilization In the United States. Pediatrics. 1998.102: 25.
8. MDH, “Variations in the Use of Health services in Minnesota by Insurance Status: Results from the 2001 Minnesota Health Access Survey.” Health Economics Program. February 2004.
9. MDH, Trends in Employer Sponsored Health insurance: Preliminary results from the 20002 Minnesota Employer Health Insurance Survey. March 2003.
10. Hakim R., Bye B. Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries. Pediatrics. 2001.108: 90.
11. Keller. Study of Selected Outcomes of the Early and Periodic Screening Diagnosis, and Treatment Program in Michigan. Public Health Reports. 1983. 98:110.
12. MDH. Uninsured in Minnesota: Perspectives of Key Informants. December 2002.
13. MDH. Accessing Health insurance in Minnesota: Barriers for the Farming Community. May 2002.